Download (London) Proceedings 2017

DAWN Clinical
Software Regional
User Workshop
(London)
Tuesday 21st February
2017
4 The Square, Milnthorpe, Cumbria, LA7 7QJ
T: +44 (0) 15395 63091
E: [email protected]
W: www.4s-dawn.com
The workshop saw a wide spectrum of DAWN users in attendance, including nurses, consultants and administrators
from Rheumatology, Dermatology, Gastroenterology and Neurology.
The morning session comprised of three customer presentations, a discussion forum and DAWN product
developments, while the afternoon involved training sessions on a number of topics.
• Working with DAWN: person or system?
Diane Home, West Middlesex Hospital, Middlesex
• Using technology to support patients with long term conditions
Colin Beevor, Queen Alexandra Hospital, Portsmouth
• Immunosuppressants in Gastroenterology
Patsy Daly, Great Western Hospital, Swindon
• Discussion Forum
The challenges of new drugs and monitoring patients
Safety benefits of DAWN software
Key challenges your service will face over the next 5 years
• Improvements and Developments in DAWN
Alistair Stewart, 4S DAWN Clinical Software
•
DAWN Training Sessions
Reporting on your patient population
Using questionnaires within DAWN
Email and SMS/text messaging in DAWN
Flagging test results
Working with DAWN - Person or System
Diane Home, Rheumatology Consultant Nurse, West Middlesex University Hospital (WMUH)
The rheumatology department at WMUH is based to the west of London covering a population of 400,000 and
with two main CCGs, Hounslow and Richmond. The service has three rheumatologists, one consultant nurse and
one specialist nurse.
WMUH started using DAWN in 2002 and upgraded to Version 7 in 2012. They currently have 1,195 active
patients on their DAWN RH system.
Diane Home reviewed several aspects of the way DAWN is used at WMUH including day-to-day management of
patients who do not attend for blood tests.
Managing non-attendance for blood tests
Within the DAWN system, monitoring intervals are set based on the treatment and a ‘grace period’ determines
when the system flags the patient up as a non-attender. This grace period could range from 5 to 28 days
depending on the monitoring period which could be 7 days to 3 months.
Example monitoring interval and grace period
From a safety perspective, WMUH wanted to catch
people earlier who had missed their blood tests.
As such, they have now set up a non-attendance
monitoring interval within DAWN of 5 days so that
regardless of the patient’s treatment monitoring
interval, the DAWN system will now flag them on
the non-attendance list after 5 days of their bloods
being due. This ensures prompt communication with the patient to remind them that they have yet to have their
bloods taken.
A new ‘fixed non-attendance’ list view has been added to the system that shows all non-attenders after 5 days and
this list is managed by using the clinic filter to split the list so that individual members of the team can see which
of their patients are flagged as non-attenders.
The list is checked and a first reminder letter is sent out to the patient. Sometimes the patient is called by telephone
for the first reminder depending on the circumstances. After two weeks, if the patient is still on the non-attenders
list, a second reminder letter is sent out to the patient as well as their GP. After a further two weeks, a STOP letter
is sent out and the patient receives no more prescriptions until they have
Quick notes section on patient screen
had a blood test.
The service is currently looking at setting up a text messaging service from
the DAWN system to remind patients that they have missed their blood tests
with the view of reducing costs, improving workflow efficiency and providing
flexible options for patients to choose their communication channels.
Improved healthcare professional communication
Another area of DAWN’s functionality that the service benefits from is the
way the team can communicate with each within DAWN and have visibility
of what is going on. The Quick Notes section and Referrals section in DAWN
is used for such communications.
The Quick Notes are used to record key information either at the time of
the patients appointment or outside of appointment times e.g. if the patients
calls the advice line or there have been changes made due to test results etc.
Using the quick notes means that each addition is time and date stamped
along with the HCPs name so that all other team members have visibility on
any important information when they access the patient record.
Page 3
members have visibility on any important information when they access the patient record.
Referrals section on patient screen
Referrals section on patient screen
One issue found recently was that ‘referrals’ within DAWN were being
One issue found recently was that
‘referrals’
within
DAWN
were to
used for non-urgent decisions such as ‘is
the patient
stable
enough
being used for non-urgent decisions such
as
‘is
the
patient
stable
have less monitoring?’.
enough to have less monitoring?’.
Should an abnormal result be received whilst this non-urgent decision is
Should an abnormal result be receivedstill pending, the result appears on a list other
whilstthan
thisthe
non-urgent
decision
usual list of
‘results
is still pending, the result appears on aflagged
list
other
than
the
usual
list
of
and not referred or checked’. Two solutions to this have been
‘results flagged and not referred or
checked’. Two solutions to
identified as the use of ‘Reminders’ on DAWN for non-urgent discussions
this have been identified as the use of
‘Reminders’ on DAWN for
and the use of the new front screen tally to highlight all abnormal results
non-urgent discussions and the use of the new front screen tally to highlight all abnormal results even if
even if already referred.
already referred.
Referrals list view
Referrals list view
Patient
identifier and
names hidden
New challenges
challenges at
separate
workflows
forfor
New
at West
WestMiddlesex
MiddlesexHospital
Hospitalinclude
include
separate
workflows
•
Infusion
clinics
–
testing
at
the
infusion
suite
on
a
different
site
• Infusion clinics – testing at the infusion suite on a different site requires
requires these
these patients
patientsto
to get
get dates
dates set
manually
and and
the DAWN
patient
Risk Class
used is
to used
streamtothese
patients
no automatic
set manually
the DAWN
patient
Risk isClass
stream
thesewith
patients
with no appointments
automatic
so
that
the
team
can
manage
the
patients
and
their
appointments
more
effectively
appointments so that the team can manage the patients and their appointments more effectively
•
project
– as– Hounslow
GPsGPs
are now
signed
up to up
NPT,
service
is currently
• Near
Near Patient
PatientTesting
Testing(NPT)
(NPT)
project
as Hounslow
are all
now
all signed
to the
NPT,
the service
is
looking
at
ways
to
identify
which
CCG
patients
belong
to
so
that
the
team
can
identify
which
ones
are
currently looking at ways to identify which CCG patients belong to so that the team can identify
suitable.
Thisare
involves
querying
the DAWN
database
which ones
suitable.
This involves
querying
the to:
DAWN database to:
oo Find
Find active
active patients
with
no
flagged
WBC,
inin
the
past
9090
days
patients with no flagged WBC,platelets
plateletsand
andALT
ALT
the
past
days
oo Exclude
Exclude patients
patients on
on treatments
treatmentsnot
notsuitable
suitablefor
forNPT
NPT
oo Identify
Identify patients
patients from
from specific
specific practices/CCGs
practices/CCGs
•
The
rheumatology
department
department
to to
investigate
incidents
• The rheumatology departmentare
areworking
workingwith
withthe
thegastroenterology
gastroenterology
department
investigate
of
patientsofwith
Neutropenia
associatedassociated
with sulfasalazine
as part ofas
a study.
involves
incidents
patients
with Neutropenia
with sulfasalazine
part of This
a study.
Thisproducing
involves
a
report
within
the
DAWN
system
based
on
a
number
of
criteria
such
as
the
definition
of
neutropenia,
producing a report within the DAWN system based on a number of criteria such as the definition
of
patient
diagnosis,
whether
the patient
is on
or combination
therapy
and time
frame.and time
neutropenia,
patient
diagnosis,
whether
themono
patient
is on mono or
combination
therapy
frame.
Diane concluded the presentation by stating that whilst DAWN is not a person SHE is definitely part of the team
at WMUH!
Diane
concluded the presentation by stating that whilst DAWN is not a person SHE is definitely part of the
team at WMUH!
Using technology to support patients with long-term conditions
Colin Beevor,
Matron
& Clinical
Nurse
Specialist,
Alexandra Hospital (QAH), Portsmouth
Using
technology
to support
patients
with
long-termQueen
conditions
Colin
spoke
about
providing
support
for
patients
prioritising
self-care
andHospital
the difficulties
forPortsmouth
patients to juggle
Colin Beevor, Matron & Clinical Nurse Specialist, Queen Alexandra
(QAH),
Colin spoke about providing support for patients prioritising self-care and the difficulties for patients to
juggle repeat appointments amongst the pressures Page
of real
4 life. Patients are interested in and often worried
by their blood tests.
repeat appointments amongst the pressures of real life. Patients are interested in and often worried by their blood
tests.
There is a need to look towards IT solutions to support patient care in the future. Systems are required not only to
help patients within the healthcare setting but also to manage their own care.
The team at QAH are particularly forward thinking when it comes to IT and are always looking at solutions that
will improve the delivery of care to patients.
Patients sit on the self-care spectrum where at one extreme, patients will take complete responsibility for managing
their own care, whilst at the other end, patients rely entirely on the healthcare professional (HCP) to manage their
care – it is important to engage with patients via IT and systems need to be considered that will help patients at
either end of the spectrum.
Remote monitoring is an option to explore for stable patients (phone call / Skype) and whilst this will not completely
replace face-to-face appointments it could certainly reduce unnecessary hospital visits. In addition, integration
between secondary and primary care systems needs to be improved in order to facilitate consistency of advice
and action from the HCP to the patient.
Patients are already engaging in healthcare through various systems, apps, websites and this is not only younger
patients but across all demographics. As a result, this also leads to patients asking more questions of their HCPs
in relation to their ‘online learning’. However, there will still be an element of the patient population who do not
wish to engage in IT.
In 2015 Portsmouth CCG and Fareham & Gosport CCG carried out a survey to ask people with one or more
long terms conditions about the care they receive from the local NHS:
• What are the best things about the care you receive for your long-term condition?
o 28 responses mentioned getting good access to consultants (including phone calls or emails, not
just face to face)
o 17 praised access to specialist nurses, both in acute and community settings
o 13 specific references to the value of a helpline
• What would you like to improve about the care you receive for your long-term condition?
o Quick access and access to specialist knowledge was mentioned along with the quality of care
o The subject of technology was raised in a variety of ways including the need for more holistic care
better information sharing between HCPs, access to results, electronic records and care plans,
GPs accessing hospital notes and virtual access to doctors and nurses
o A desire for information was a common theme – about services, conditions, treatments, drugs,
allowing effective self-management
• A further question concerning the ranking of usefulness of a variety of options saw the
highest ‘most useful’ response received for:
o More information to help manage the condition yourself
o More convenient ways to consult with your doctor (e.g. email/online)
QAH are looking at ways to engage better with patients and via more channels in order to reach patients in
flexible ways. A YouTube channel provides informative and educational videos for patients to access whilst other
social media channels can be used to communicate and educate through Q&A sessions etc.
The rheumatology service is also looking at setting up a multi-media room for holding virtual clinics via Skype
and other communication channels.
The service are also looking at near patient testing, particularly within retail outlets such as Boots and investigating
the need to get the results from these locations into the DAWN system.
Page 5
Innovations in the use of IT systems to improve care will only work if everyone is
behind it and wants to use it. However, whilst advances are being made in this
respect, the NHS is still very paper heavy and this leads to an increase risk of
losing information.
Colin referenced the importance of patient choice and future options to get
tested in the most convenient way. The risks of mis-communication where
patients get two differing instructions by contacting the helpline twice are real
and accessibility of information at weekends is also an increasing demand.
Immunosuppressants in Gastroenterology
Patsy Daly, Gastroenterology Specialist Nurse, Great Western Hospital (GWH)
GWH serves a population of 350,000 across Swindon and Wiltshire. The DAWN system has been used within the
rheumatology department for 8 years whilst the gastroenterology department went live with the DAWN system in
September 2015.
Prior to the DAWN system, monitoring of gastroenterology patients was coordinated via spreadsheets.
Example of spreadsheet used prior to DAWN system
The spreadsheets were used
primarily to identify patients who
had blood tests due but this was
a particularly lengthy process and
often saw the nurses staying after
work to complete the task.
With the DAWN system in place,
much of the workflows within the
clinic are automated and key
patient groups are flagged on the
system including non-attenders
and patients with abnormal
results, reducing much of the
manual workload previously
undertaken by the nurses.
Currently, IBD (Crohn’s disease and Ulcerative Colitis), Autoimmune Hepatitis and Post Liver Transplant patients
are managed using the DAWN software and the following medications are monitored:
•
•
•
•
•
•
•
Azathioprine
Mercaptopurine
Methotrexate
Ciclosporin
Tacrolimus
Mycophenolate
Biologic therapies: (Infliximab, Adalimumab, Golimumab, Vedolizumab)
Full blood count, liver function, CRP, kidney function, thiopurine methyltransferase TPMT, Pre Biologic screeningHep B&C EBV are monitored for all patients.
The DAWN administrator interacts directly with the system for around 25 hours per week and the specialist nurses
use the system to complete daily reviews of blood results and checking pre-treatments. The system is also used
Page 6
in clinic when seeing patients in order to request prescriptions and bloods. Clinicians interact with DAWN if the
nurses have concerns and the test results are outside of the set parameters.
The local CCGs (Swindon and Wiltshire) have both supported the use of the DAWN gastroenterology system
and all patients across both CCGs are initiated at GWH using DAWN. After 3 months, if the patient is stable,
those from Wiltshire CCG are put out to the GPs for monitoring. Whilst the Swindon CCG patients continue to be
monitored by GWH with the DAWN system.
In terms of moving forward with the DAWN system, the gastroenterology service is looking at the following:
•
•
•
•
5-aminosalicylic acid (5-ASA) patients to be added to DAWN so that their liver function can be monitored
Adding hemochromatosis and coeliac disease patients to DAWN for monitoring
Introducing a demographics interface from PAS to DAWN to increase safety and ensure effective
communications with patients
Setting up text messages reminders from DAWN to patients who have not had blood tests done to reduce
the time spent currently chasing non-attenders
Discussion Forum
The customer presentations were followed by a discussion forum that saw delegates break into smaller groups in
order to discuss and then share the outcomes of their discussions on topics including the challenges of new drugs
and monitoring patients; key safety benefits of DAWN; and service challenges over the next 5 years.
Some of the points that came out of these discussions included:
•
•
•
•
•
•
•
•
Improved communication required between consultants and nurses when initiating patients on Biologics
to ensure all relevant screening tests completed
Potential to use a questionnaire in DAWN designed specifically for biologic initiation – increasing patient
safety
Everyone in the team needs to be committed to using DAWN
Not having to review all results including ‘normal’ results to determine which are abnormal helps the HCP
focus on what is important as ‘abnormal’ results only are flagged in the system – this is a real safety benefit
Able to query the DAWN system to look at trends within patient population and sub groups of patients
The safety benefits of the DAWN system increase the more you use it
Fragmented care with different systems will prove to be more challenging in the future and integration
between them will be important, particularly in managing patient expectations in relation to consistency
of care and their need for information
The role of GPs and their reluctance to monitor/manage patients on biologics could prevent shared care Some New Developments in DAWN
Alistair Stewart, 4S DAWN Clinical Software
Timed Message
New ‘Timed Message’ functionality has been added to the DAWN. This functionality
allows pre-defined messages to be sent to groups of either patients or healthcare
professionals, either by email or by SMS/text message, at a pre-defined time on specific
days of the week. For example, reminders to patients of blood tests due, or alerts that
they have missed their blood tests, alerts to HCPs to inform them that there are patient
in DAWN with abnormal results that need reviewing.
Page 7
Hyperlinks from Front Screen
Hyperlinks from Front Screen Tallies to List Views. DAWN can be configured to display a set of significant tallies
on the front screen.
New Password Reset Process
When you log in using the temporary password, you are immediately prompted to change your temporary
password for a new one of your choosing. The new Change Your Password form is much more helpful than
before.
Concurrent User Warning
DAWN will now display a Concurrent User Warning to a
user when opening a patient record that is already being
viewed by another DAWN user.
A popup box will be displayed showing the name of the
user(s) already viewing the same patient record.
A warning banner will be displayed at the top of the
patient record at all times whilst the user is on the same
patient record as another user.
DAWN Training Sessions
Heather Stevenson, 4S DAWN Clinical Software
Report – count of patient status
A training session on the DAWN system was held in
the afternoon and covered four key areas, Reporting
on your patient population; DAWN questionnaires;
Timed messages (email and SMS text messaging);
and Flagging test results.
This provided an excellent opportunity for customers to
learn more about using their DAWN system in new ways,
refresh existing knowledge and ask questions about
various areas of the DAWN system.
Questionnaires tab within the DAWN patient record
For more information on DAWN Products and Services:
Please call from the UK: 015395 63091. Fax 015395 62475
Or Internationally 44 15395 63091. Fax 44 15395 62475
E-mail: [email protected]
Web Site: http://www.4s-dawn.com
Or write to
4S DAWN Clinical Software, 4 The Square
MILNTHORPE, Cumbria, LA7 7QJ, England, UK